Take Home Message: Workers and athletes
exposed to greater elbow stress (from vibration, high forces, or high
repetition) may be more likely to develop elbow osteoarthritis.

Elbow
anatomy is complex and the joint is often put under mechanical stress. This stress spans across both sexes and many
occupations, from athletics to construction or assembly. Review of the
literature fails to demonstrate if osteoarthritis (OA) of the elbow joint is
related to trauma, age-related changes, occupation, or if there is no
relationship between OA and these possible risk factors. Therefore, Spahn and
colleagues reviewed previous research and conducted a case-control study to compare
people with no elbow joint issues to a group of patients who experienced chronic
symptoms that required elbow surgery. The researchers recruited 218 adults (126
controls, 92 cases) between 30 and 60 years old who reported the last 10 years’
worth of injuries, physical activities, occupational stress, and potential risk
factors for OA. The researchers evaluated the stress on the elbow from
occupational and athletic activities by considering the force, vibration, and repetitiveness
of activity. The case group also received X-rays to assess the severity of OA.
Nearly half of all participants self-reported occupational stress to the elbow
joint and/or involvement in sports activities. Almost half those who
participated in sports were in sports that stress the elbow joint (e.g.,
throwing sports, gymnastics). People exposed to occupation-based elbow stress
were almost ~3.8 times more likely to have elbow OA or cartilage damage. Specifically,
exposure to heavy work, repetition, and vibration, especially low-frequency
vibrations (for example demolition hammer), increased the chances of elbow OA.
Construction workers or adults who work in a continuous assembly line tended to
have higher degrees of cartilage damage. People who participated in
elbow-stressing sports were ~2.5 times more likely to have elbow OA or
cartilage damage. The cartilage damage was mainly to the radiocapitellar
articulation. The presence of olecranon osteophytes was higher in construction
and assembly line workers than for those who worked in an office setting or in
healthcare. These results confirm previous research findings that exposure to
low-frequency vibrations is a risk factor for elbow OA.

This
study and systematic review provides valuable information regarding OA and
occupational stress. At the same time, prior research reveals that the development of elbow OA, from biomechanical factors and sports- or occupational-related stressors, can take anywhere from 3 to 27 years post-activity. The researchers admit
that it would be ideal to prospectively study people to determine the true
incidence of elbow OA among these high-risk populations. Further, the control
group included only patients who had no history of elbow OA or cartilage damage
from clinical indicators, even though they may have had asymptomatic
radiographic OA. Nevertheless, clinicians can use this information to guide prevention,
treatment, and rehabilitation of elbow injuries. The risk of damage to the
cartilage and/or radiographic OA in the elbow joint is rare when compared to
the hip or knee joints, however clinicians should still be aware of
occupational and recreational activities that place stress on the elbow joint. This
may be particularly relevant in regards to prevention strategies. Clinicians
may take steps to modify the stress on elbows. For example, clinicians may
modify a patient’s exposure to vibration, high forces, or high repetitions by
having workers/athletes alternate tasks or applying pitch counts.

Questions for Discussion: Have you seen
a case of OA of the elbow joint in your practice? Did the patient’s occupation align with the
research findings?

2
comments:

I think this study highlights multiple very important findings that can be generalizable to healthcare professionals no matter what population they are working with. The results of this study show that individuals who work physically demanding jobs that involve the upper extremity are more likely to develop OA even more so than overhead, “over-use” athletes. As an athletic trainer, injury prevention is an essential part of my job while working with athletic teams, and we often work with coaches to improve mechanics to reduce the risk of injury. As athletic trainers become more popular in occupational settings, studies like this strengthen the argument for AT’s to work with the physically active working population. If an athletic trainer was present at these working sites, they may be able to observe and correct poor mechanics used by employees to reduce the stress placed not only on the elbow, but also on all joints throughout the body. This study also noted that it can take decades for OA to develop and become symptomatic in some individuals. I think future research could focus on looking at elderly individuals who were either athletes or worked physically demanding jobs, and determine the long-term functional outcomes in these differing populations.

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